HB 437 2022
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to collaborative practice of certified 2
registered nurse anesthetists; amending s. 395.0191, 3
F.S.; authorizing an advanced practice registered 4
nurse who is certified as a registered nurse 5
anesthetist to administer anesthesia in collaboration 6
with specified licensed physicians; amending s. 7
464.003, F.S.; revising and providing definitions; 8
amending s. 464.012, F.S.; revising general functions 9
a certified nurse anesthetist may perform in 10
collaboration with specified licensed health care 11
practitioners; amending s. 960.28, F.S.; conforming a 12
cross-reference; providing an effective date. 13
14
Be It Enacted by the Legislature of the State of Florida: 15
16
Section 1. Paragraph (b) of subsection (2) of section 17
395.0191, Florida Statutes, is amended to read: 18
395.0191 Staff membership and clinical privileges. — 19
(2) 20
(b) An advanced practice registered nurse who is certified 21
as a registered nurse anestheti st licensed under part I of 22
chapter 464 shall administer anesthesia in collaboration with 23
under the onsite medical direction of a health care practitioner 24
professional licensed under chapter 458, chapter 459, or chapter 25
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466. For purposes of this paragraph, the term "collaboration" 26
has the same meaning as provided in s. 464.003 , and in 27
accordance with an established protocol approved by the medical 28
staff. The medical direction shall specifically address the 29
needs of the individual patient . 30
Section 2. Subsections (10) though (22) of section 31
464.003, Florida Statutes, are renumbered as subsections (11) 32
through (23), respectively, subsection (2) is amended, and a new 33
subsection (10) is added to that section, to read: 34
464.003 Definitions. —As used in this part, the term: 35
(2) "Advanced or specialized nursing practice" means, in 36
addition to the practice of professional nursing, the 37
performance of advanced -level nursing acts approved by the board 38
which, by virtue of postbasic specialized education, training, 39
and experience, are appropriately performed by an advanced 40
practice registered nurse. Within the context of advanced or 41
specialized nursing practice, the advanced practice registered 42
nurse may perform acts of nursing diagnosis and nursing 43
treatment of alterations of the health status. The advanced 44
practice registered nurse may also perform acts of medical 45
diagnosis and treatment, prescription, and operation as 46
authorized within the framework of an established supervisory 47
protocol or in collaboration with a l icensed health care 48
practitioner as provided under s. 464.012 . The department may, 49
by rule, require that a copy of the protocol be filed with the 50
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department along with the notice required by s. 458.348. 51
(10) "Collaboration" means the collaborative relati onship 52
between a health care practitioner licensed under chapter 458, 53
chapter 459, or chapter 466, who is performing a medical or 54
surgical procedure or directly involved in such procedure, and 55
an advanced practice registered nurse who is certified as a 56
registered nurse anesthetist performing the functions described 57
in s. 464.012(4)(b) before, during, or after a medical or 58
surgical procedure. The term includes the joint formulation and 59
discussion of patient treatment, in which each health care 60
practitioner contributes his or her respective expertise in the 61
management and delivery of health care. 62
Section 3. Subsection (3) and paragraph (b) of subsection 63
(4) of section 464.012, Florida Statutes, are amended to read: 64
464.012 Licensure of advanced practice registered nurses; 65
fees; controlled substance prescribing. — 66
(3) An advanced practice registered nurse shall perform 67
those functions authorized in this section within the framework 68
of an established protocol that must be maintained on site at 69
the location or locations at which an advanced practice 70
registered nurse practices, unless the advanced practice 71
registered nurse is registered and practicing under s. 464.0123 , 72
or is certified and practicing as a certified registered nurse 73
anesthetist in collaboratio n with a licensed health care 74
practitioner. In the case of multiple supervising physicians in 75
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the same group, an advanced practice registered nurse must enter 76
into a supervisory protocol with at least one physician within 77
the physician group practice. A pr actitioner currently licensed 78
under chapter 458, chapter 459, or chapter 466 shall maintain 79
supervision for directing the specific course of medical 80
treatment. Within the established framework, an advanced 81
practice registered nurse may: 82
(a) Prescribe, dispense, administer, or order any drug; 83
however, an advanced practice registered nurse may prescribe or 84
dispense a controlled substance as defined in s. 893.03 only if 85
the advanced practice registered nurse has graduated from a 86
program leading to a master's or doctoral degree in a clinical 87
nursing specialty area with training in specialized practitioner 88
skills. 89
(b) Initiate appropriate therapies for certain conditions. 90
(c) Perform additional functions as may be determined by 91
rule in accordance with s. 464.003(2). 92
(d) Order diagnostic tests and physical and occupational 93
therapy. 94
(e) Order any medication for administration to a patient 95
in a facility licensed under chapter 395 or part II of chapter 96
400, notwithstanding any provisions in chapter 465 or chapter 97
893. 98
(4) In addition to the general functions specified in 99
subsection (3), an advanced practice registered nurse may 100
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perform the following acts within his or her specialty: 101
(b) The certified registered nurse anesthetist may, in 102
collaboration with a licensed health care practitioner to the 103
extent authorized by established protocol approved by the 104
medical staff of the facility in which the anesthetic service is 105
performed, perform any or all of the following: 106
1. Determine the health status of the patient as it 107
relates to the risk factors and to the anesthetic management of 108
the patient through the performance of the general functions. 109
2. Based on history, physical assessment, and supplemental 110
laboratory results, determine , with the consent of the 111
responsible physician, the appropriate type of anesthesia within 112
the framework of the protocol . 113
3. Order under the protocol preanesthetic medication. 114
4. Perform under the protocol procedures commonly used to 115
render the patient insensible to pain durin g the performance of 116
surgical, obstetrical, therapeutic, or diagnostic clinical 117
procedures. These procedures include ordering and administering 118
regional, spinal, and general anesthesia; inhalation agents and 119
techniques; intravenous agents and techniques; a nd techniques of 120
hypnosis. 121
5. Order or perform monitoring procedures indicated as 122
pertinent to the anesthetic health care management of the 123
patient. 124
6. Support life functions during anesthesia health care, 125
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including induction and intubation procedures, the use of 126
appropriate mechanical supportive devices, and the management of 127
fluid, electrolyte, and blood component balances. 128
7. Recognize and take appropriate corrective action for 129
abnormal patient responses to anesthesia, adjunctive medication, 130
or other forms of therapy. 131
8. Recognize and treat a cardiac arrhythmia while the 132
patient is under anesthetic care. 133
9. Participate in management of the patient while in the 134
postanesthesia recovery area, including ordering the 135
administration of fluids and drug s. 136
10. Place special peripheral and central venous and 137
arterial lines for blood sampling and monitoring as appropriate. 138
Section 4. Subsection (2) of section 960.28, Florida 139
Statutes, is amended to read: 140
960.28 Payment for victims' initial forensic physical 141
examinations.— 142
(2) The Crime Victims' Services Office of the department 143
shall pay for medical expenses connected with an initial 144
forensic physical examination of a victim of sexual battery as 145
defined in chapter 794 or a lewd or lascivious offens e as 146
defined in chapter 800. Such payment shall be made regardless of 147
whether the victim is covered by health or disability insurance 148
and whether the victim participates in the criminal justice 149
system or cooperates with law enforcement. The payment shall b e 150
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made only out of moneys allocated to the Crime Victims' Services 151
Office for the purposes of this section, and the payment may not 152
exceed $1,000 with respect to any violation. The department 153
shall develop and maintain separate protocols for the initial 154
forensic physical examination of adults and children. Payment 155
under this section is limited to medical expenses connected with 156
the initial forensic physical examination, and payment may be 157
made to a medical provider using an examiner qualified under 158
part I of chapter 464, excluding s. 464.003(16) s. 464.003(15); 159
chapter 458; or chapter 459. Payment made to the medical 160
provider by the department shall be considered by the provider 161
as payment in full for the initial forensic physical examination 162
associated with the collection of evidence. The victim may not 163
be required to pay, directly or indirectly, the cost of an 164
initial forensic physical examination performed in accordance 165
with this section. 166
Section 5. This act shall take effect July 1, 2022. 167